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Presentation, follow-up, and outcomes among African/Afro-Caribbean men on active surveillance for prostate cancer: experiences of a high-volume UK centre

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dc.contributor.authorKum, F.
dc.contributor.authorBeckmann, K.
dc.contributor.authorAya, H.
dc.contributor.authorSingh, S.
dc.contributor.authorSandhu, P.
dc.contributor.authorSra, S.
dc.contributor.authorRusere, J.
dc.contributor.authorZisengwe, G.
dc.contributor.authorSantaolalla, A.
dc.contributor.authorCathcart, P.
dc.contributor.authorChallacombe, B.
dc.contributor.authorBrown, C.
dc.contributor.authorPopert, R.
dc.contributor.authorDasgupta, P.
dc.contributor.authorVan Hemelrijck, M.
dc.contributor.authorElhage, O.
dc.date.issued2021
dc.description.abstract<h4>Background</h4>Experiences of African/Afro-Caribbean men on active surveillance (AS) for prostate cancer (PCa) in the United Kingdom (UK) are not well documented. We compared follow-up appointments, adherence, and clinical outcomes among African/Afro-Caribbean men on AS at a high-volume UK hospital with other ethnicities.<h4>Methods</h4>Men with confirmed low-intermediate risk Pca who attended the AS clinic (2005-2016) and had undergone ≥1 follow-up biopsy (n = 458) were included. Non-adherence (defined as >20% missed appointments), suspicion of disease progression (any upgrading, >30% positive cores, cT-stage > 3, PIRADS > 3), any upgrading from diagnostic biopsy and conversion to active treatment (prostatectomy, radiotherapy or hormone therapy) according to ethnicity (African/Afro-Caribbean versus other ethnicities) were assessed using multivariable regression analysis.<h4>Results</h4>Twenty-three percent of eligible men were recorded as African/Afro-Caribbean, while the remainder were predominantly Caucasian. African/Afro-Caribbean men had slightly lower PSA at diagnosis (median 5.0 vs. 6.0 ng/mL) and more positive cores at diagnosis (median 2 vs. 1). They had a substantially higher rate of non-attendance at scheduled follow-up visits (24% vs. 10%, p < 0.001). Adjusted analyses suggest African/Afro-Caribbean men may be at increased risk of disease progression (hazard ratio [HR]: 1.38; 95% confidence interval [CI] 0.99-1.91, P = 0.054) and upgrading (HR: 1.29; 95% CI 0.87-1.92, P = 0.305), though neither reached statistical significance. No difference in risk of conversion to treatment was observed between ethnic groups (HR: 1.03; 95% CI 0.64-1.47, P = 0.873).<h4>Conclusions</h4>African/Afro-Caribbean men on AS for PCa in the UK are less likely to adhere to scheduled appointments, suggesting a more tailored service addressing their specific needs may be required. While African/Afro-Caribbean men were no more likely to convert to treatment than Caucasian/other men, findings of a potentially higher risk of disease progression signal the need for careful selection and monitoring of African/Afro-Caribbean men on AS. Larger prospective, multicentre studies with longer follow-up are required to provide more definitive conclusions.
dc.identifier.citationProstate Cancer and Prostatic Diseases, 2021; 24(2):549-557
dc.identifier.doi10.1038/s41391-020-00313-0
dc.identifier.issn1365-7852
dc.identifier.issn1476-5608
dc.identifier.orcidBeckmann, K. [0000-0002-9798-1479]
dc.identifier.urihttps://hdl.handle.net/11541.2/147032
dc.language.isoen
dc.publisherSPRINGERNATURE
dc.relation.fundingNHMRC 1124210
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1124210
dc.rightsCopyright 2021 The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.
dc.source.urihttps://doi.org/10.1038/s41391-020-00313-0
dc.subjectHumans
dc.subjectProstatic Neoplasms
dc.subjectPrognosis
dc.subjectProstatectomy
dc.subjectSurvival Rate
dc.subjectRisk Factors
dc.subjectRetrospective Studies
dc.subjectFollow-Up Studies
dc.subjectProspective Studies
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectCaribbean Region
dc.subjectMale
dc.subjectWatchful Waiting
dc.subjectHospitals, High-Volume
dc.subjectUnited Kingdom
dc.subjectEthnicity
dc.subjectWhite People
dc.subjectBlack People
dc.titlePresentation, follow-up, and outcomes among African/Afro-Caribbean men on active surveillance for prostate cancer: experiences of a high-volume UK centre
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9916487402301831

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